Provider Demographics
NPI:1164297321
Name:RODRIGUEZ, DAIGNESSE
Entity Type:Individual
Prefix:MISS
First Name:DAIGNESSE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. INDUSTRIAL REPARADA #396 CALLE DR. LUIS F. SALAS
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-410-6880
Mailing Address - Fax:787-841-7101
Practice Address - Street 1:URB. INDUSTRIAL REPARADA #396 CALLE DR. LUIS F. SALAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-410-6880
Practice Address - Fax:787-841-7101
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR015887183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician